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OP-ED | How Is Connecticut’s Health Insurance Exchange Really Doing?

by | Apr 2, 2014 1:51pm () Comments | Commenting has expired | Share
Posted to: Opinion, Health Care Opinion

The dust is settling from the dash to the March 31st finish line to sign people up for insurance coverage through Connecticut’s health insurance exchange, Access Health CT. So how did we do? Are people going to get decent coverage? Is it affordable? Will the rate of uninsured in our state drop significantly? Will people be any healthier?

What’s working:

  • When you hear that Connecticut’s exchange is the “best in the country” they are referring to operations. Our website works better than most; so well in fact, that they are considering selling our system and expertise to other states. The call center also works well, with short wait times. This is probably because of their policy to embrace consumer complaints as a “blessing,” offering clues to improve the system.
  • The navigators and assisters did a phenomenal job of getting 118,000 people enrolled into Medicaid, almost the total number experts predicted to become eligible. Because Medicaid is income limited, it is likely that the vast majority of new enrollees were previously uninsured. This is a big accomplishment engaging hard-to-reach populations and overcoming the stigma of Medicaid coverage. The job was made easier by the program’s significant progress in recent years improving the quality of care and attracting more providers to participate.
  • What’s not working:

  • Enrollment into insurance plans may be reaching internal exchange goals, but too many, maybe most, of Connecticut’s uninsured are not buying, even with subsidies.
  • It’s not clear yet how many of the exchange’s customers were previously uninsured but it is likely to be less than half. Saving money for some people who were already purchasing insurance is a good thing, but the point of the Affordable Care Act was to cover the uninsured.
  • When asked why people aren’t buying insurance, the overwhelming answer is the price. Connecticut’s premiums are fourth highest in the U.S. — the highest among state-based exchanges.
  • The good news is that we know how to fix this. All our surrounding states negotiate premiums with insurers in their exchanges and all have lower prices. So far, Connecticut policymakers have rejected this common sense policy and other options to make coverage affordable.
  • Connecticut’s exchange is still resisting independent consumer advocacy input and membership on the board. But insurers are well represented and too many board members have conflicting interests. Independent consumers and advocates have crucial expertise to make the exchange successful — expertise the exchange can’t buy at any price.
  • What is unclear:

  • There are early signs that people signing up for insurance through the exchange are older than most uninsured state residents. To be affordable, the exchange needs to attract young, healthy people spreading the costs of care across a broad pool. If enrollment is skewed toward older people with high costs, premiums will rise even higher, as happened to the Charter Oak program.
  • It’s not clear if there will be enough providers participating in exchange plans to meet the need. If people pay their premiums every month but can’t see a doctor when they need one, enrollment will drop. Buying a plastic card doesn’t make people healthier.
  • While the jury is still out on Connecticut’s insurance exchange, there is a lot more to the Affordable Care Act. Children can stay on their parents’ policies until age 26, people can’t be denied coverage for pre-existing conditions, and dozens of innovative programs to control health care costs are starting up. The Affordable Care Act is working and Connecticut’s exchange will be a part of that, but there is still a lot of work to be done.

    Ellen Andrews is the executive director of the Connecticut Health Policy Project.

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    (3) Archived Comments

    posted by: dano860 | April 3, 2014  8:18am

    Great job of reporting Ellen.
    Lets hope they will address and resolve the”, what’s not working,” issues you highlighted here. That should allow them to drill deeper and possibly get pricing down and enrollment of the youth up.

    posted by: MickeyHerb | April 3, 2014  10:09am

    Contributing editor Ellen Andrews wrote a thought-provoking column called “How is CT’s Health Insurance Exchange Really Doing” in your newsletter on April 2.  She ended up concluding that the jury is still out on the success of Access Health CT, and that we still have a lot of work to be done in providing health care coverage to all CT citizens.  She rightly points out that there are still far too many uninsured who have yet to sign up for health care coverage, even with subsidies, most of those who have signed up (absent Medicaid) were almost certainly NOT previously uninsured, and that we have failed so far to attract enough young people to the exchange.
    Though we often disagree, I agree wholeheartedly with her conclusion.  Where I disagree strongly with her is on her suggestions for how to improve the exchange.  She argues that the exchange should be able to negotiate rates with its participating health plans, and that the exchange’s board of directors needs additional consumer advocates. 
    In Connecticut, we have an outstanding state insurance department that thoroughly reviews and approves health plan premiums.  It is hard for me to imagine how rate review could be improved by having the exchange also reviewing and approving those rates.  Not only would the process be needlessly duplicative,but the exchange really has no existing expertise to conduct such reviews.  And if it did and sought lower premiums than the state insurance department felt were minimally adequate, the insurer’s financial stability could be jeopardized.  And, subsequently, the insurer might decide to quit the exchange.  Already, several insurers in CT have chosen to sit on the sidelines with respect to the public exchange.  We don’t need any more choosing to do so. 
    As for board representation, we already have a state law preventing exchange board members from working for an insurer,  a hospital, a practicing physician, or an insurance brokerage agency.  Frankly, we need some insurance and health care delivery expertise on that board, and it is insulting to existing board members to imply that they don’t have the consumers’ interest at heart.
    Both Ellen and I agree that we need to focus on how to reduce costs in CT.  To me, that means we need to be wary of any any additional state-mandated benefits, and we need to get both the federal and state governments to pay their fair share of the costs to provide Meidicare and Medicaid to our state’s beneficiaries of these programs.  We also need to be sure that the provider consolidation that is sweeping our state is all about better integration of services, and not about demands for higher pricing.  And health plans need to be able to offer value-based networks without the state insisting that these health plans sign on “any willing provider”. 
    We are on our way to substantial reform of our health care system.  We just need to be ever vigilant that it is occurring in the best way possible for our citizenry.

    posted by: Joebigjoe | April 3, 2014  10:49am

    I’m not going to argue the results of CT’s exchanges because I do think that individual state exchanges without federal intervention is part of the solution.

    However, let’s not confuse the “possible” pro’s of the CT situation with that on a National level.

    7 million people signed up? Blue Cross is saying today that they feel 20% of them are phantom in that they have never paid a dollar of premium.

    7 million represents 2% of the US population.

    They have done a number on the US healthcare system for 2% or less of the population.

    If this program was so popular, the King, since we no longer have balance of powers, would not have delayed most of the mandates that will impact many millions of people negatively until after the next election.

    Do it NOW if it’s so great. Take away exemptions for unions and big donors and lets crank this baby up now.

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